Combined Behavioral Support and Medication Offers Smokers Best Chance of Quitting

Numerous randomized clinical trials have shown the
effectiveness of the two major forms of smoking cessation treatment –
behavioral support and medication - in helping smokers quit. Researchers have
now demonstrated that this approach can successfully translate to the "real
world" and that a combination of the two treatments offers almost a threefold
chance of success over attempts to quit without using a cessation aid. Their
findings are published in Mayo Clinic
Proceedings.

"Randomized clinical trials have a high internal
validity, but because they are conducted under very strict conditions, they do
not reflect the real world in which these treatments are supposed to be used,"
explains Daniel Kotz, PhD, from the University of Maastricht in the
Netherlands. "We therefore conducted a study to compare the various smoking
cessation methods in the real world."

Investigators conducted a prospective cohort study in
a random sample of 1,560 adult smokers who took part in an English national
household survey between November 2006 and March 2012. They used data from the
Smoking Toolkit Study, an ongoing research program designed to provide
information about smoking cessation and factors that promote or inhibit it at a
population level.

Smokers were included in the study when they were
smoking tobacco at the time of an initial interview, responded to a
questionnaire six months later, and made at least one quit attempt during the
study period. The smokers each used one of the following four cessation aids:
prescription medication (nicotine replacement therapy, bupropion, or
varenicline) in combination with specialist behavioral support delivered by a
UK National Health Service Stop Smoking Service (4.8%); prescription medication
with brief advice (20.8%); nicotine replacement therapy bought over the counter
(29.9%); or none of these (44.5%).

A total of 23% reported not smoking at the end of the
six-month period. The investigators found that smokers who used a combination
of specialist behavioral support and medication in their quit attempts reported
higher levels of urges to smoke than did smokers who tried to quit unaided.
After adjusting for this, they found smokers using the combination approach had
almost three times the odds of success than did those who used neither
medication nor behavioral support. A combination of prescription medication
along with limited behavioral support was also more effective than unaided
quitting. They found however that smokers who bought nicotine replacement
therapy (NRT) over the counter with no behavioral support had a reduced success
rate.

"As far as we are aware, our study is the first prospective
cohort study comparing prescription medication when offered with specialist
behavioral support with prescription medication offered without such support. A
major strength of our study is the use of a representative sample of the
English population that was sufficiently large to detect an effect of
specialist behavioral support despite its low prevalence," says Dr. Kotz. "The
results clearly show that the combination of prescription medication with
behavioral support is the most successful method. More smokers should be guided
towards these forms of treatment."

"Tobacco use continues to be prevalent and deadly in the
United States and worldwide. Further, smoking cessation is one of the most
important health behavior changes that we can encourage in our patients.
Hundreds of clinical trials that included thousands of patients have
demonstrated the efficacy of combined behavioral therapy and pharmacotherapy
for tobacco-dependence treatment," comments J. Taylor Hays, MD, Director of the
Mayo Clinic Nicotine Dependence Center in Rochester, Minnesota "The research by
Dr. Kotz and his colleagues demonstrates that this approach can be translated
to the real world and provide real benefit. This is a case where there is
happily little difference between 'theory and practice.' Health systems,
hospitals, clinics, and providers now need to practice the well-established standard
of care to save real lives in their real world."

About Mayo Clinic ProceedingsThe flagship journal of Mayo Clinic and one of the premier
peer-reviewed clinical journals in general medicine, Mayo Clinic Proceedings
is among the most widely read and highly cited scientific publications for
physicians, with a circulation of approximately 125,000. While the Journal
is sponsored by Mayo Clinic, it welcomes submissions from authors worldwide,
publishing articles that focus on clinical medicine and support the
professional and educational needs of its readers. www.mayoclinicproceedings.org

About ElsevierElsevier is a global information analytics business that helps institutions and professionals advance healthcare, open science, and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com